A History of the Presidency - Illness and disability

Presidential illness since the beginning has been a factor in the life of
the nation. Nevertheless, the health of presidents until relatively
recently was rarely spoken of; it was regarded as nobody's business
but the president's. Moreover, even after the advent of modern
medicine, the unspoken proscription against speaking about the body in
Victorian America played a role in keeping off limits the details of the
chief executives' physical condition. Consequently, facts are known
today that contemporaries were unaware of. George Washington, for example,
was barely in office in 1789 when he developed a painful carbuncle on his
left thigh. He may have been near death from the staphylococcal infection
and high fever that accompanied it. His intense suffering, which in the
end included the surgery he had to endure without anesthetic, necessitated
rebuilding the carriage he traveled in so that he could lie in it at full
length. The following year he contracted a cold, which, it was said, then
turned into influenza and pneumonia—bringing despair for his
recovery. We may only speculate on how the national history might have
been different if the Father of His Country had died on either occasion:
the first when the government was being launched under his hand as the
indispensable man, and the second when the critical struggle over the
first Bank of the United States was being played out.

When Andrew Jackson came to office in 1829 heralded as formidable,
indestructible Old Hickory, he was in truth a debilitated man. He was
still feeling the effects of a pistol shot long before lodged in his left
shoulder, and suffering perpetually from intestinal bleeding, possibly
caused by the calomel he took for his recurrent dysentery. We can never
know how his frailty affected his performance as Chief Executive.

Presidents Polk and Truman, even though they served a century apart, have
sometimes been compared as unexpected presidents who showed themselves to
be feisty leaders forced to take the country into war. Both had been
sickly children. Polk suffered as a boy from a bladder stone, eventually
removed by surgery, that robbed him of a normal childhood. He was proud
that his career as president and war leader proved he was no longer, as he
once called himself, "the meager boy, with pallid cheeks, oppressed
and worn with disease."

Truman, too, endured a boyhood blighted by illness. At the age of eight,
paralyzed by the effects of diphtheria, he had to be wheeled around in a
baby carriage. Amply coddled, he became, simply stated, a sissy. Indeed,
he liked to believe that he could arrange his sister's curls better
than his mother could. But he was determined to be manly. Growing up he
set his heart on winning an appointment at the Military Academy at West
Point, but this ambition was frustrated by his "flat
eyeballs" (his own designation). In World War I he showed his
mettle as an officer in an artillery unit and this service in uniform had
an abiding influence on his political life. As president he demonstrated
enormous respect for military men, including especially Generals Mark
Clark, George C. Marshall, and Dwight D. Eisenhower.

The question of how far the president's health ought to come
officially and contemporaneously to the public's knowledge did not
trouble the country in earlier days. When, for instance, word leaked out
in the 1880s that President Chester A. Arthur was suffering from
Bright's disease, a usually fatal kidney ailment, the White House
silenced public speculation by denouncing the story as malicious gossip. A
notable case occurred in 1893, shortly after Grover Cleveland's
second inauguration. He had begun to suffer from a lesion in his mouth
that was soon diagnosed as a cancer, requiring immediate attention. Apart
from the president's personal stake, the political stakes were
enormous. Cleveland was a committed defender of the gold standard; if he
should die, his vice president, Adlai E. Stevenson of Illinois (a
grandfather of the Adlai E. Stevenson who twice ran unsuccessfully for
president against Dwight D. Eisenhower in the 1950s), who was a fervent
advocate of the free silver policy would be president. Because it would be
risking exposure to take Cleveland to a clinic or hospital, the work was
done aboard a friend's yacht anchored in New York's East
River near Bellevue Hospital. The medical staff was ordered to stay out of
sight lest they be recognized by Bellevue's resident doctors. To
keep the president steady during the procedure, as the boat sailed slowly
up the river, his chair was lashed tight to the mast. To avoid doing
external surgery, one of the doctors, William W. Keen, a Philadelphia man,
who had served in the Civil War and had studied abroad, employed a cheek
retractor he had brought home from Paris in 1866. Operated on a second
time a few weeks later, the president was fitted with a prosthesis that
did not show on his face. The public was none the wiser until
1917—almost a quarter of a century later—when Dr. Keen, in
an article in the
Saturday Evening Post,
finally broke the embargo on the story.

Although one in four presidents has been disabled at some time during his
term of office, the disability of a president was not dealt with
appropriately even after Woodrow Wilson was stricken by a massive stroke
in 1919 that severely affected his gait and speech. His wife, Edith Galt
Wilson, screened his mail and the list of his visitors, and is sometimes
referred to, therefore, as the "first woman president."
Wilson's medical history, had it been known in 1912 when he ran for
the White House the first time, would have raised a flag of caution. The
public was unaware that he had been suffering strokes since 1898. Many
Americans will always believe that although the nation as a whole was bent
on being quit of Europe after the end of the World War I, the failure of
the Senate to ratify the Treaty of Versailles was in some measure related
to the personality deficits the president had undergone.

A generation later, Franklin D. Roosevelt, aided as Wilson had been by a
White House doctor willing to cover up what he knew, was an ailing man
even as he presented to the world his smiling, confident face. At the end
of 1943 when the Allied landings in Normandy were being planned, the
president was suffering acutely from hypertensive congestive heart
disease, and hypertension that resisted efforts at reduction. The medical
people in the president's entourage well knew that by D-Day in
1944, the president was barely able to concentrate on affairs of state.
When he traveled to the Pacific to visit the American commanders and
ostensibly to lay plans for the final assault on Japan later in the year,
he was actually seeking surcease from the daily cares of his office.

Although there was much gossip in 1944 when FDR ran for a fourth term that
he was mortally ill, the voters, ignorant of the truth, elected him
handily. During the canvass, though, when the invasion of France was in
its critical moments, the president at a private lunch with his running
mate, Harry Truman, urged him for his own safety and for the good of the
country, to avoid campaigning by airplane. "This time, we may need
you," the president told him presciently. Still, talking to the
press after this portentous meeting, Truman offered traditional words of
reassurance, saying that he found the president well and hearty. Not until
1970 was a full account of FDR's medical condition made
public—in an article in the
Annals of Internal Medicine,
a medical journal, by Dr. Howard Bruenn, the young naval aide who had
been called in to treat the president.

After Eisenhower suffered a heart attack in 1955, he and Vice President
Nixon came to an informal agreement that the vice president would take
over the responsibilities of the presidency in a comparable emergency in
the future. In the next years first when Eisenhower underwent bowel
surgery and then after he suffered a "brain spasm" there
was, he would say, "a gap when I could not carry out the duties of
my office." The openness of the Eisenhower administration in
reporting on the various ailments the general came down with while in the
White House, was no example for the Kennedy administration. It followed
the style of the Cleveland and Wilson administrations. President Kennedy
suffered, beginning when he was thirty years old, from adrenal
insufficiency, or Addison's disease, a fact confirmed by the
autopsy performed after his assassination, but kept secret at the behest
of the Kennedy family. When Kennedy underwent back surgery in 1954 because
of his disease, he received the last rites of the Roman Catholic Church.
Kennedy had kept fit by taking regular supplements of cortisone and
similar drugs in replacement of the adrenal hormone. Still, victims of the
disease taking cortisone and its ilk are subject to mood swings and
stomach inflammation, including ulcers. Moreover, the face is sometimes
made fuller by the medicines.

In his quest for the nomination in 1960, Kennedy had declared himself
"the healthiest candidate for President in the country."
This was a backhanded reference to his opponent, Senator Lyndon B.
Johnson, who had suffered a severe heart attack in 1955. When the truth
about JFK's medical condition was finally revealed in the
Journal of the American Medical Association
in 1967, many people declared that if it had been known in 1960, it is
doubtful that he would have been nominated, let alone elected.

Johnson's heart condition was constantly on his mind. He liked to
say that he had had "the worst heart attack you could have and
still live." He confessed that every time he passed Wilson's
portrait, he trembled at the thought of himself lying helpless in the
White House. He saw to it that there was defibrillation equipment on every
floor, and he carried with him a copy of his electrocardiogram for
emergency reference. The frenetic way in which he managed the Great
Society legislation led some people to conclude that he felt instinctively
he had no time to lose. Johnson and House Speaker John McCormack, who was
next in line of succession, came to an agreement similar to the
Eisenhower-Nixon arrangement. When President Reagan underwent surgery for
colon cancer in 1985, he temporarily transferred the powers of his office
to Vice President George H. W. Bush.

At last the Twenty-fifth Amendment, ratified in 1967, aimed at dealing
officially with the vexing matter of presidential and vice presidential
succession and disability. It provided formally for the first time that
when death or resignation removes a president, the vice president becomes
president. When a vice president is similarly removed, the president will
choose a successor who takes office at once upon confirmation by a
majority vote of both houses of Congress. And when a president writes to
the president pro tem of the Senate and to the Speaker of the House that
he is unable to perform the duties of his office—and until he
informs them otherwise—the vice president becomes acting president.
Similarly, if a majority of the cabinet (or of any other body that
Congress designates) declares that the president cannot discharge his
duties, the vice president becomes acting president. When the president
declares that he is able to resume his office, he must so inform the
president pro tem of the Senate and the Speaker of the House. If there is
disagreement as to whether he is so able, Congress under specific time
restraints must respond appropriately. In recent elections it has been
common for candidates to issue medical reports on their physical
condition, but these are not always complete.